This document provides guidance for primary care pharmacists on obtaining medicines information to answer patient queries. It outlines various reference sources available both online and through local medical libraries. These include the British National Formulary, Medicines and Healthcare products Regulatory Agency, Clinical Knowledge Summaries and National Institute for Health and Care Excellence. The document also describes the types of queries best referred to Medicines Information Centers and important questions to consider when contacting these centers.
BMJ Feature: Flipping the model for access to patient recordsPatients Know Best
Lack of progress in NHS England’s efforts to provide universal access to medical records has led to the development of independent initiatives, reports Ben Adams
Gates Healthcare Associates is a consulting firm that provides extensive clinical, regulatory, real estate, contract evaluation and business development services and expertise to pharmacies, medical practices, hospitals, and healthcare organizations
Considering a career as a pharmacist? These professionals provide patients with prescription medications and information for safe use practices, health and wellness screenings, immunizations and general health advice. This guide provides all the necessary information and resources to get started. Find out everything you need to know about this occupation, including qualifications, pay and standard duties.
Health Systems face the same drug cost management challenges as many other organizations. They may also have the added component of shouldering risk from payers without the ability to fully manage this important aspect of care. A new model is emerging that will afford Health Systems the opportunity to better manage risk by taking a collaborative approach to managing pharmacy benefits for their employees and their risk partners.
This webinar covers:
- The basics of traditional pharmacy benefit management revenue strategies
- Potential misalignment between a traditional pharmacy benefit model and an integrated model
- Benefits of an Integrated PBM
- How to put the model into practice
5 Ways Your Pharmacy Can Boost Your Revenue CycleCompleteRx
With rising drug costs and decreasing reimbursements contributing to shrinking margins (in 2014, according to Modern Healthcare, 61.3 percent of healthcare providers reported decreased margins from the previous year), hospitals continue to scrutinize their revenue cycles to ensure they stay in the black, and there’s an oft-overlooked resource they would do well to consider: pharmacy. Historically, the hospital pharmacy has been labeled a cost generator, but there are actually many ways this strategic department can positively impact each stage of the revenue cycle – from point of service to claim submission and more. This webinar will explore innovative tactics, including optimized processes, improved data management, and creative patient programs, which hospital pharmacies across the country can leverage to boost overall hospital revenue.
BMJ Feature: Flipping the model for access to patient recordsPatients Know Best
Lack of progress in NHS England’s efforts to provide universal access to medical records has led to the development of independent initiatives, reports Ben Adams
Gates Healthcare Associates is a consulting firm that provides extensive clinical, regulatory, real estate, contract evaluation and business development services and expertise to pharmacies, medical practices, hospitals, and healthcare organizations
Considering a career as a pharmacist? These professionals provide patients with prescription medications and information for safe use practices, health and wellness screenings, immunizations and general health advice. This guide provides all the necessary information and resources to get started. Find out everything you need to know about this occupation, including qualifications, pay and standard duties.
Health Systems face the same drug cost management challenges as many other organizations. They may also have the added component of shouldering risk from payers without the ability to fully manage this important aspect of care. A new model is emerging that will afford Health Systems the opportunity to better manage risk by taking a collaborative approach to managing pharmacy benefits for their employees and their risk partners.
This webinar covers:
- The basics of traditional pharmacy benefit management revenue strategies
- Potential misalignment between a traditional pharmacy benefit model and an integrated model
- Benefits of an Integrated PBM
- How to put the model into practice
5 Ways Your Pharmacy Can Boost Your Revenue CycleCompleteRx
With rising drug costs and decreasing reimbursements contributing to shrinking margins (in 2014, according to Modern Healthcare, 61.3 percent of healthcare providers reported decreased margins from the previous year), hospitals continue to scrutinize their revenue cycles to ensure they stay in the black, and there’s an oft-overlooked resource they would do well to consider: pharmacy. Historically, the hospital pharmacy has been labeled a cost generator, but there are actually many ways this strategic department can positively impact each stage of the revenue cycle – from point of service to claim submission and more. This webinar will explore innovative tactics, including optimized processes, improved data management, and creative patient programs, which hospital pharmacies across the country can leverage to boost overall hospital revenue.
HIGHLIGHTED: Dissemination of Patient-Specific Information from Devices by De...NextWorks
This is the highlighted version of FDA's Guidance for Industry: Dissemination of Patient-Specific Information from Devices by Device Manufacturers from June 2016.
When these guidances come out, I typically go through them and highlight the most relevant portions for those who need to skim through or refresh their memory.
Global Medical Second Opinion Market is currently doing well and is on the riseAravind Gupta
Medical Second Opinion Market: By Disease (Cancer, Cardiac Disorders, Diabetes, Injuries and Others); By Service Providers (Hospitals, Online and Offline Medical Second Opinion Providers and Health Insurance Players) & By Geography - Forecast (2015 - 2020)
Certain insurance companies require prior approval to give coverage for medications. Prescribing physicians must gain approval before billing their claims to avoid denials.
Best practices paper on the risks, standards and challenges of Health Risk Management- Testing in the Healthcare domain by Devi.K from Siemens. Paper submitted during QAI's 12th International Software Testing Conference
In late 2011, the FDA released a document addressing how the pharmaceutical industry can and should respond to requests about off-label drug usage. This POV provides more information about the guidance document, highlights the key issues, and offers use cases to consider in the digital realm.
This slide is in relevance to my previous slide on Generic medicine which was my project of Rural Marketing in third semester. It gives an insight what is the awareness level of Generics in our nation, a sample survey conducted online .
Hope it will give you some clarity over the topic!
3.A Basic Overview of Health Information Exchange.pdfBelayet Hossain
What is health information exchange? A hie software enables healthcare providers to securely communicate clinical data in line with HIPAA regulations. In other words, it’s a system for securely moving a client’s health information from one county to another.
https://itphobia.com/a-basic-overview-of-health-information-exchange/
SPL/DailyMed Jamboree Workshop – Using DailyMed Drug Product Label Data” on October 28, 2013.
Presentation of Stephen A. Weitzman, J.D., LL.M.
Video and slides at http://www.nlm.nih.gov/mesh/spl_workshop.html October 2013
عرض تقديمي دعائي عصري أبيض وأرجواني.pptxOmarAlqadi5
Types of water in pharmaceutical preparation and sources including purified water, distilled water,water for injection, water for irrigation, bacteriostatic water, potable water , drinking water, deionization,pyrogen test
9/12/2018 Print
https://content.ashford.edu/print/McNeill.2947.17.1?sections=ch18,ch19,ch20,ch21&content=content&clientToken=3e86a398-8c91-136b-ab99-55495… 1/16
18 Partners HealthCare System
Thomas H. Davenport
Partners HealthCare System (Partners) is the single largest provider of healthcare in the Boston area. It consists of 12 hospitals, with more than 7,000
af�iliated physicians. It has 4 million outpatient visits and 160,000 inpatient admissions a year. Partners is a nonpro�it organization with almost $8
billion in revenues, and it spends more than $1 billion per year on biomedical research. It is a major teaching af�iliate of Harvard Medical School.
Partners is known as a “system,” but it maintains substantial autonomy at each of its member hospitals. While some information systems (the
electronic medical record, for example) are standardized across Partners, other systems and data, such as patient scheduling, are speci�ic to particular
hospitals. Analytical activities also take place both at the centralized Partners level and at individual hospitals such as Massachusetts General Hospital
(MGH) and Brigham and Women’s Hospital (usually described as “the Brigham”). In this chapter, both centralized and hospital-speci�ic analytical
resources are described. The focus for hospital-speci�ic analytics is the two major teaching hospitals of Partners—MGH and the Brigham—although
other Partners hospitals also have their own analytical capabilities and systems.
Centralized Data and Systems at Partners
The basis of any hospital’s clinical information systems is the clinical data repository, which contains information on all patients, their conditions, and
the treatments they have received. The inpatient clinical data repository for Partners was initially implemented at the Brigham during the 1980s.
Richard Nesson, the Brigham and Women’s CEO, and John Glaser, the hospital’s chief information of�icer, initiated an outpatient electronic medical
record (EMR) at the Brigham in 1989.1 (http://content.thuzelearning.com/books/McNeill.2947.17.1/sections/ch18#ch18end01) This EMR contributed outpatient data to the
clinical data repository. The hospital was one of the �irst to embark on an EMR, though MGH had begun to develop one of the �irst full-function EMRs as
early as 1976.
A clinical data repository provides the basic data about patients. Glaser and Nesson came to agree that in addition to a repository and an outpatient
EMR, the Brigham—and Partners after 1994, when Glaser became its �irst CIO—needed facilities for doctors to input online orders for drugs, tests, and
other treatments. Online ordering (called CPOE, or Computerized Provider Order Entry) would not only solve the time-honored problem of
interpreting poor physician handwriting, but could also, if endowed with a bit of intelligence, check whether a particular order made sense or not for a
particular patient. Did a prescribed drug comply with best-known medical practice, and did the pa.
HIGHLIGHTED: Dissemination of Patient-Specific Information from Devices by De...NextWorks
This is the highlighted version of FDA's Guidance for Industry: Dissemination of Patient-Specific Information from Devices by Device Manufacturers from June 2016.
When these guidances come out, I typically go through them and highlight the most relevant portions for those who need to skim through or refresh their memory.
Global Medical Second Opinion Market is currently doing well and is on the riseAravind Gupta
Medical Second Opinion Market: By Disease (Cancer, Cardiac Disorders, Diabetes, Injuries and Others); By Service Providers (Hospitals, Online and Offline Medical Second Opinion Providers and Health Insurance Players) & By Geography - Forecast (2015 - 2020)
Certain insurance companies require prior approval to give coverage for medications. Prescribing physicians must gain approval before billing their claims to avoid denials.
Best practices paper on the risks, standards and challenges of Health Risk Management- Testing in the Healthcare domain by Devi.K from Siemens. Paper submitted during QAI's 12th International Software Testing Conference
In late 2011, the FDA released a document addressing how the pharmaceutical industry can and should respond to requests about off-label drug usage. This POV provides more information about the guidance document, highlights the key issues, and offers use cases to consider in the digital realm.
This slide is in relevance to my previous slide on Generic medicine which was my project of Rural Marketing in third semester. It gives an insight what is the awareness level of Generics in our nation, a sample survey conducted online .
Hope it will give you some clarity over the topic!
3.A Basic Overview of Health Information Exchange.pdfBelayet Hossain
What is health information exchange? A hie software enables healthcare providers to securely communicate clinical data in line with HIPAA regulations. In other words, it’s a system for securely moving a client’s health information from one county to another.
https://itphobia.com/a-basic-overview-of-health-information-exchange/
SPL/DailyMed Jamboree Workshop – Using DailyMed Drug Product Label Data” on October 28, 2013.
Presentation of Stephen A. Weitzman, J.D., LL.M.
Video and slides at http://www.nlm.nih.gov/mesh/spl_workshop.html October 2013
عرض تقديمي دعائي عصري أبيض وأرجواني.pptxOmarAlqadi5
Types of water in pharmaceutical preparation and sources including purified water, distilled water,water for injection, water for irrigation, bacteriostatic water, potable water , drinking water, deionization,pyrogen test
9/12/2018 Print
https://content.ashford.edu/print/McNeill.2947.17.1?sections=ch18,ch19,ch20,ch21&content=content&clientToken=3e86a398-8c91-136b-ab99-55495… 1/16
18 Partners HealthCare System
Thomas H. Davenport
Partners HealthCare System (Partners) is the single largest provider of healthcare in the Boston area. It consists of 12 hospitals, with more than 7,000
af�iliated physicians. It has 4 million outpatient visits and 160,000 inpatient admissions a year. Partners is a nonpro�it organization with almost $8
billion in revenues, and it spends more than $1 billion per year on biomedical research. It is a major teaching af�iliate of Harvard Medical School.
Partners is known as a “system,” but it maintains substantial autonomy at each of its member hospitals. While some information systems (the
electronic medical record, for example) are standardized across Partners, other systems and data, such as patient scheduling, are speci�ic to particular
hospitals. Analytical activities also take place both at the centralized Partners level and at individual hospitals such as Massachusetts General Hospital
(MGH) and Brigham and Women’s Hospital (usually described as “the Brigham”). In this chapter, both centralized and hospital-speci�ic analytical
resources are described. The focus for hospital-speci�ic analytics is the two major teaching hospitals of Partners—MGH and the Brigham—although
other Partners hospitals also have their own analytical capabilities and systems.
Centralized Data and Systems at Partners
The basis of any hospital’s clinical information systems is the clinical data repository, which contains information on all patients, their conditions, and
the treatments they have received. The inpatient clinical data repository for Partners was initially implemented at the Brigham during the 1980s.
Richard Nesson, the Brigham and Women’s CEO, and John Glaser, the hospital’s chief information of�icer, initiated an outpatient electronic medical
record (EMR) at the Brigham in 1989.1 (http://content.thuzelearning.com/books/McNeill.2947.17.1/sections/ch18#ch18end01) This EMR contributed outpatient data to the
clinical data repository. The hospital was one of the �irst to embark on an EMR, though MGH had begun to develop one of the �irst full-function EMRs as
early as 1976.
A clinical data repository provides the basic data about patients. Glaser and Nesson came to agree that in addition to a repository and an outpatient
EMR, the Brigham—and Partners after 1994, when Glaser became its �irst CIO—needed facilities for doctors to input online orders for drugs, tests, and
other treatments. Online ordering (called CPOE, or Computerized Provider Order Entry) would not only solve the time-honored problem of
interpreting poor physician handwriting, but could also, if endowed with a bit of intelligence, check whether a particular order made sense or not for a
particular patient. Did a prescribed drug comply with best-known medical practice, and did the pa.
Eysenbach AMIA Keynote: From Patient Needs to Personal Health ApplicationsGunther Eysenbach
AMIA Spring Conference, May 29th-31st, 2008, Phoenix/AZ. PHR Track Keynote covers: An international perspective on the importance of PHR/PHA development & research; patient needs (and other drivers of Personal Health Records); Emerging technological trends, with an emphasis on what Eysenbach calls PHR 2.0 – impact of Web 2.0 approaches e.g. to reduce attrition in ehealth applications
Eysenbach: Personal Health Applications and Personal Health RecordsGunther Eysenbach
Keynote talk at the AMIA Spring Conference in the PHR track (Personal Health Records), focussing on international develoments and a new paradigm which I call PHR 2.0
Digital Pharma: Evolution and Revolution in Marketing & SalesLen Starnes
A review for non-pharma audiences of evolutionary and revolutionary changes in pharma marketing and sales since the mid 90s. Presented at ENG's Effective Web Marketing and Search Engine Marketing conference, Brussels, November, 2007.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Med info for primary care pharmacists2007
1. Medicines Information
for the
Primary Care Pharmacist
Noshi Iqbal
Lead Pharmacist
Clinical Training & Development
November 2007
2. Learning Outcomes
� By the end of this session, you will be able
to:
� Use the most appropriate reference
source to answer common MI enquiries
� Know when to refer enquiries to Medicines
Information Centres
3. Problems faced by Primary Care
Pharmacists
� Don’t have access to general resources
that would be available in a Pharmacy or
Med Info Centre.
� Limited to the Internet, most websites
need registering or subscriptions.
� Doubt over reliable and trustworthy sites
for information.
4. Types of MI Enquiries in Primary
Care
� General medical & pharmacy enquiries (dosage,
frequency, formulation)
� Immunisation & travel advice
� Adverse drug reactions & drug interactions
� Drugs in Pregnancy & Lactation
� Renal & hepatic disease
� Paediatrics (off-licence use of drugs)
� Specialist queries (mental health, cancer)
� Miscellaneous (out of stock)
5. Joining the Bradford & Airedale
Medical Libraries
� Joining any of the four libraries below automatically provides access to all four
facilities, including borrowing rights and other services. Show your ID badge
to join.
� Bradford & Airedale tPCT Library Service
Library Team, Ground Floor, Douglas Mill, Bowling Old Lane, Bradford, BD5
3JR Tel: 01274 237484 Fax: 01274 539232
� E-Mail - rebecca.hewitt@bradford.nhs.uk
� Airedale NHS Trust Library and Information Service
Medical Education Centre, Airedale General Hospital, Skipton Road,
Keighley, BD20 6TD. Tel: 01535 294412 Fax: 01535 292196
E-mail - airedale.library@anhst.nhs.uk
� Library & Health Promotion Resources
Lynfield Mount Hospital, Heights Lane, Bradford, BD9 6DP
� Tel: 01274 363194 Fax: 01274 363194 E-Mail -
library.lynfield@bdct.nhs.uk
� Bradford Teaching Hospitals Health Library & Information Service
� Field House, BRI.
� NHS staff in Bradford & Airedale are also permitted to join and borrow from:
Universities of Leeds & Bradford
6. Obtaining an athens log-in
� Access hundreds of journals online
� Wealth of information
� Most key journals offer full text (though available after 6
months)
� Library services will allow photocopy of current journals
(within copyright guidelines)
� Need to contact Rebecca Hewitt (let her know that you
work for Bradford & Airedale tPCT):
rebecca.hewitt@bradford.nhs.uk or 01274 237484
� Webpage: http://www.athensams.net/ and click on
‘MyAthens’ on left hand side.
� Once you have joined the library service it will be easier
to obtain an athens password. The libraries have many
publications on athens access and registration.
8. British National Formulary
� Most important reference source
� Available online at www.bnf.org
� Need to log-in with athens or
personal log-in (need to register
for)
� Advantage of online BNF that can
copy & paste info from webpage
straight into patient’s records
� Can link straight through to a drug
monograph from SystmOne (right
click on drug, scroll down to BNF
information). Will need to log-in at
BNF screen (some practices can
do straight link without log-in).
� Children’s BNF available online at
http://bnfc.org/bnfc/
9. Online Medicines Compendium
� Full Summary of
Product Characteristics
(SPC’s) and Patient
Information Leaflets
(PILs) available for the
majority of drugs
� No log-in needed
� Information can be
copied and pasted in
patient records
� PILs can be
downloaded and saved
in pdf
� SPC’s and PILs can be
printed
� Contact telephone
numbers for drug
manufacturer’s med info
dept or customer
services provided
10. MIMS
� Available online at
www.healthcarerepublic.
com//home/pharmacist
� Registration required
� Unfortunately, cannot
access clinical tables /
guides without
subscription
� However, can obtain info Can sign up to receive free
weekly email bulletins which have
on latest products and a summary of the best pharmacist
licence changes clinical features, jobs and news
11. PACE Guidelines
� Available online at
http://www.learnonline.nhs.uk/P
ACE
� PACE are responsible for
bringing together national
guidance and local specialist
expertise in Bradford and
Airedale around the promotion of
good health and the prevention
and treatment of ill health. This
consists of a guidance
document, educational learning
events, evidence-based tool kits
and district wide clinical audit. PACE Team
� Guidelines and toolkits are 2nd Floor
available on site to be viewed Douglas Mill
and downloaded. Bowling Old Lane
� Pharmacists are encouraged to Bradford
attend PACE educational events BD5 7JR
(as long as practices are not Tel: 01274 237406
disrupted significantly and work
is covered) Email: pace@bradford.nhs.uk
12. ADRs & Yellow Card data
� As pharmacists we have duty to fill in
yellow cards if we come across an
ADR with any drug during med
reviews with patients.
� Keep a copy for yourselves and send
CMS a copy (looks good on record).
� Sometimes need to know if a
particular drug is cause for an ADR –
can look at yellow card data though
bear in mind that this info is not a true
reflection of incidence, but is info on
reports submitted
� Yellow card data is (for the majority of �Availableon the MHRA website
cases) better than ringing the
company med info dept as they then �www.mhra.gov.uk
have a legal right to know about �Monographs are called:
patient details, and there is a risk of ‘Drug Analysis Prints (DAPs)’
breaching patient confidentiality and
obtaining consent could alarm patient
etc. Example of monograph (fluoxetine)
� Yellow card data provides an Key tip – MHRA website is awful to
alternative source of info when the use. To find DAPs go to main site,
BNF & SPC does not mention the and change last digit of web
ADR. address ‘5’ to ‘742’. Will take you
direct to the DAPs page.
13. Product Availability
� Common enquiries via patients
that cannot get hold of their
medicines, or referred from GP
asking about supply problem
and whether worth switching
patient to alternative
� UCLH Solutions website
detailed list of product
problems
� www.uclhsolutions.com
� Username & password:
cmspharmacists
� Click on – solutions – product
shortage list for list of drugs Can print off whole list as pdf document
with supply problems and date (updated weekly) to give to
for resolution community pharmacists / GPs
� Can confirm discontinuations
� MHRA drug recalls all
available
14. UKMi national website
� UK Medicines Information
Network homepage
� www.ukmi.nhs.uk
� Most clinical areas are
password protected for MI
pharmacists
� Useful to know as a
pharmacist which clinical areas
available to help with enquiry
(can then ring MI to ask
answer)
� Website has a fridge database
and a latex database – big lists
of products
� Most other clinical sections are
directed to other websites
(mostly NeLM)
15. National electronic Library for
Medicines (NeLM)
� www.nelm.nhs.uk
� Need to register
� Previously known as
‘druginfozone’
� Registration enables daily MI
email alerts
� One of the best MI sites
available
� Previously NPA resources
(travel immunisation, malaria
prophylaxis, diluents, sugar
Q and A section has reviewed and
contents, E-numbers) all
critically evaluated answers to
available to download, now
common questions. Have all been
removed
updated (currently 129 Qs available).
� Info on drugs on the horizon Examples:
� Large section for prescribing 1) Is it safe to use metformin in HF?
(for pharmacists) 2) Switching between antidepressants
16. Primary Care Question Answering
Service
� www.clinicalanswers.
nhs.uk
� Similar to NeLM Q&A
but more specific to
primary care
� All questions are
answered with
references but are
limited in depth (are
not systematic
reviews)
� Can view questions References are common primary care
by speciality sources like prodigy and CKS,
(condition) or can but summarised concisely
search site
17. Clinical Knowledge Summaries
(CKS)
� Incorporates Prodigy
� Part of NHS Libraries
� Useful info on disease
management
� Covers drug
treatments
� Easy to use site
� Can print leaflets for
patients
� Need to register
18. National Prescribing Centre (NPC)
� www.npc.co.uk
� Being updated at
moment
� MeReC bulletins,
therapeutic reference
sheets, info on new
medicines on horizon
� Medicines Management
& Partnership sections
etc
� Vast source of
information
19. National Service Frameworks (NSFs)
� Available on the
DoH website
� www.dh.gov.uk
� NSFs are long
term strategies for
improving specific
areas of care. They
set measurable
goals within set Can also download the ‘Green Book’
time frames. From DoH site (vaccination & immunisation
Guide)
� All available to
download from site
20. National Institute of Clinical
Excellence (NICE) � NICE is an independent
organisation responsible for
In the “Our Guidance” section, the providing national guidance on
different types of guidance that NICE promoting good health and
preventing and treating ill
produces (e.g. Technology Appraisals, health.
Clinical Guidelines and Interventional � Appraisals & guidelines
Procedures) can be found – both those available to download as full
finalised and those in progress. documents or summaries
The Guidance can be found by: � www.nice.org.uk
Looking at the list of ‘type’ i.e.
Technology appraisals, Clinical
Guidelines or Interventional
procedures.
Looking at the list of ‘topics’, which
categorise guidance into health topics.
Looking in the Compilation, which is a
summary of all the Guidance
produced.
21. Immunisation & vaccination
� www.immunisation.
nhs.uk
� Information on all
the vaccines and
immunisation
schedules
� Refers to other
sources for links
� Easy to use site –
good to recommend
to patients for
further information
23. Enquires that need to be referred to
a MI Centre
� Pregnancy & Breastfeeding
� Complex renal & hepatic disease
� Paediatric (especially neonate) where off-licence
info is required
� IV enquiries
� Herbal interaction enquiries
� Specialist enquiries – psychiatric drugs,
chemotherapy
24. Ringing Medicines Information
� Each hospital has a MI Centre; then there are
regional (specialist centres e.g. Newcastle is
specialist for pregnancy & poisoning).
� Some hospitals (e.g. Bradford) are not funded to
provide a MI service to primary care so they may
try to brush you off (they have an overwhelming
number of enquiries to deal with). However,
they cannot refuse to take your call as this would
be against UKMi protocol.
� Try and ring MI only when the enquiry is
complex, and needs specialist input. The more
time you can give them to prepare the answer
the better response you will get.
� Bradford MI: 01274 364598
25. MI requirements
� MI Centres tend to ask a lot of
questions in order for them to
prepare a comprehensive answer
for you, so ensure you know all the
details and have done the basic
looking up.
26. Key questions to
think about
when doing MI
MI Centres will ask you these
questions so try to know their
answers before ringing them
27. General questions – for all enquiries
� Is this a general enquiry or is it about a
specific patient?
� What is your name?
� What is your job/your role/your interest
in this enquiry?
� How should I contact you?
� When do you need an answer?
28. Adverse drug reactions
� Establish patient’s age if relevant
� Ask about the indication for the drug and any relevant
medical history (e.g. renal function)
� List all current and recent drugs (include OTC products,
herbal medicines, drug abuse).
� Consider any history of ADRs and or allergies.
� Ask for the details of the suspected reaction including
signs & symptoms, and severity.
� Establish when the suspected reaction began (especially
in relation to starting drug treatment) and whether the
drug has been stopped.
� Ask how the patient has managed and how he/she is
now.
Remember to check yellow card data when dealing with
ADRs
29. Drug interactions
� Which of the drugs is the patient already taking?
How long have they been taken for?
� Has the enquirer or patient read about an
interaction somewhere? If so, where?
� If the patient is already taking both drugs, have
any problems been identified or investigated?
� If there is an interaction, is there any reason why
alternative drugs can’t be used instead?
� What is the patient’s liver and renal function?
� Is the patient taking any other medicines?
� If any ongoing or future monitoring would be
required, who would do this?
30. Drugs in breast-feeding
� Identify drug, indication, dose, frequency, route of
administration and duration of treatment.
� What would happen if the drug is stopped, or not used?
� Has any alternative been considered or tried?
� Has mum already been taking the drug? Has the baby
already been exposed to it in pregnancy or breast-
feeding, and if so have any problems been identified?
� How old is the infant, and is he/she premature or full-
term?
� Is the baby well? Is there anything to suggest that the
infant may be at increased risk of drug harm – such as
impaired kidney or liver dysfunction?
� Who is in a position to change therapy if necessary or
document your advice in the patient’s notes? Who else
needs to know the answer to this enquiry?
31. Drugs in renal disease
� Establish age, weight and height of patient.
� Check the degree of renal failure, whether it is
acute or chronic, and whether renal function is
stable, deteriorating or fluctuating.
� Is the patient currently taking the drug in
question, if so what dose and frequency?
� What is the indication for the drug and have
alternatives been considered?
� Which if any, renal replacement therapy is being
used?
� Ask about the timing of any renal replacement
therapy as necessary.
32. Drugs in liver disease
� Establish the clinical condition of the patient, age, and
presumed diagnosis.
� Results of LFTs (including clotting screen), biopsies and
other diagnostic liver tests. Are the LFTs stable or
changing?
� What is the patient’s renal function?
� If drug-induced hepatotoxicity is suspected, is the
patient currently taking the drug in question, if so what
dose and frequency? What other drugs are being taken
or were taken recently?
� If requesting advice on dosage or suitability of a drug in
hepatic dysfunction, what is the indication for the drug
and have alternatives been considered? What agent
would normally be used if the patient did not have liver
dysfunction?
33. Pharmacokinetics
� Identify the drug, indication, dose, frequency,
route and duration of therapy.
� Check the patient’s age, gender, weight,
concurrent medication and medical history
including renal and hepatic function.
� Check if any previous drug levels have been
taken and if so, check the exact time they were
taken in relation to the drug and confirm the units
of measurement.
� Have any interacting drugs been started (or
stopped) which may affect levels?
34. Palliative care
� If enquirer asks about compatibility of drugs in
a syringe driver, check the drugs, doses,
diluent and volume. If you are unable to find
compatibility data, think about alternative
drugs, routes or separate syringe drivers.
� If enquirer asks about symptom control,
establish indication and what drug or non-drug
options they have tried already.
� If the patient is unable to tolerate oral
administration, explore other routes with
enquirer.
� Check concomitant medication and concurrent
disease including renal and liver function.
35. Alternative medicine
� Is the patient already taking the alternative
medicine or do they want to start taking it?
� Identify the alternative medicine, indication,
route, strength, dose and frequency. If
applicable, how long has it been taken for?
� Has the patient self-diagnosed the condition that
they are seeking to treat? If they have, perhaps
they should consider speaking to a healthcare
professional first.
� Does the patient take any conventional
medication? Is there any history of ADRs or
allergies?
� Check the past medical history.
36. Substance misuse
� How certain are you that the amount of drug taken and the
frequency of use is correct? Users may lie about the
quantities consumed and the purity of street drugs also
varies very widely.
� Has a urine screen been organised? What were the
results?
� Does use of the drug relate to a single exposure, short-
term use, or a persistent habit?
� How is the subject taking the drug (e.g. injection, oral)?
� Is the subject taking other drugs? It may be important to
know about other substances (e.g. tobacco, prescribed
drugs): some enquirers panic when they hear about an
illicit drug, or automatically blame it for all the patient’s
problems, and don’t ask further questions.
� If the enquirer has used drug slang terms that you are not
familiar with, ask them to clarify.
� Many enquiries concern side effects, interactions or use in
pregnancy.
37. Travel Medicine
� Identify the traveller(s).
� Check age, concurrent medication and medical history
(e.g. acute illness, immunosuppression, psoriasis,
epilepsy, neuropsychiatric disorders, renal or hepatic
impairment).
� Check whether any female travellers are pregnant or
breast-feeding.
� Identify the exact destination(s) to be visited.
� Find out about the nature of the travel and type of
accomodation (i.e. is traveller backpacking through
rural areas or staying in a good quality urban hotel?
� Check the length of stay and the proposed travel date.
38. Immunisation
� Identify the vaccine that is to be administered (is it live or
not?)
� If it’s not obvious, ask about why the vaccine is required,
and when.
� Is the vaccine really necessary? Even if it is necessary,
could delaying vaccination help solve the enquirer’s
problem? Does the patient require a primary course or a
booster dose?
� If relevant, enquire about which vaccines the patient has
had before.
� Does the patient have any contra-indication to
vaccination? Consider acute illness, previous allergy or
adverse reactions, pregnancy and immunosuppresion.
� Ask about concurrent disease and concomitant
medication.
Use the ‘Green Book’ available on the DoH website.
39. Product availability
� Why do you need this product? Why is an
alternative in the BNF not acceptable?
� What is the product to be used for?
� Establish where the enquirer heard about the
product.
� Ask for exact spelling, any known manufacturer,
strength, dosage form and country of origin.
� Ask how much is needed, and when it is required.
Remember to use UCLH website, can always ring
customer services at drug companies for
confirmation about availability.
Unlicensed specialists like IDIS & Durbin may be
able to source supply of drug.
40. Drugs in Pregnancy
� Assess whether prospective or retrospective exposure – is the woman
actually pregnant now, or planning to become pregnant?
� Identify the drug, indication, dose, frequency, route, and the duration
of exposure.
� How many weeks pregnant was the woman when she first started
taking the drug?
� How many weeks pregnant is she now?
� What drug has the woman taken during previous pregnancies for any
similar condition?
� Has the woman taken the drug in question during a previous
pregnancy?
� Has the woman had any previous pregnancies and what was the
outcome?
� Is there a family history of malformations or history of recurrent
abortions?
� Have any investigations been performed (e.g. ultrasound scans)?
� For chemical exposure enquiries additional questioning may be
needed to establish substance involved, approximate quantities,
duration of exposure per day, protective measures taken etc.
41. Administration of medicines
� If asked about administration of IV drugs think about: dose,
infusion fluid, fluid volume, rate, availability of intravenous
access and whether any other drugs are being given IV.
� For drugs put down enteral feeding tubes, ask about: type
of tube, where the end of the tube is, & the feeding
regimen. Think about alternative administration routes or
drugs.
� If the enquiry is about a patient who is NBM prior to surgery
establish the drugs & doses, and the duration of expected
NBM. Again, think about alternative routes or drugs.
� Similarly if a patient becomes dysphagic, ask about the
drugs & doses and when/whether their swallow is expected
to improve.
Hospitals have a Wrexham Maelor Hospital & NEEMMC
guidelines to deal with crushing tablets enquiries (can ring
company too).
42. Compatibility of parenteral drugs
� Which drugs are currently being mixed?
� Which drugs are you planning to mix?
� What are the concentrations of the drugs, and what diluents
are being used?
� How will the drugs be mixed and what types of IV lines are
being used?
� Which of the drugs to be mixed are essential? (if not obvious)
� What other drugs is the patient being given parenterally?
� Is the number of IV access points limited? If so, why?
� Can alternative routes of administration be considered? If
not, why?
� Establish how the patient is fed – an enteral feed tube offers
a potential alternative administration route; if TPN is being
used this can create additional compatibility problems.
43. Clinical trials
� If you are asked to identify a specific
clinical trial, gather as much data as
possible about the trial before trying to
look for it: drug name, manufacturer,
date of publication, disease area, any
acronym, authors’ names and so on.
� Check with the drug company / trial rep
for further info.
� Check NeLM website for info
44. Choice of therapy & drug dosing
� Check the indication even if it appears obvious
(e.g. don’t assume amitriptyline is for depression)
and the preferred route.
� Check the patient’s age and weight if appropriate.
� Check the patient’s renal and liver function.
� Check the past medical history to ensure the drug
is appropriate for the patient.
� Does the patient take any other medicines?
� Has the patient tried any other drug/non-drug
therapy already?
� Does the patient have any allergies?
45. Stuck?
� Give Noshi a ring
� New mobile number –
07515 278437
� Bradford’s ex-MI
Pharmacist (2.5 years)
Medicines Information is fun – providing information is an
important part of being a pharmacist